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This essay uses an enactive approach to map out the ways Ontario teachers, students, and parents have reimagined online mathematics education at the K-12 level during the COVID-19 pandemic. The essay highlights the importance of education researchers using an appropriate framework in understanding the emerging mathematics education realities. It encourages education researchers to pay attention to this call to action while recognizing that such an action is not without challenges. To address the challenges, education researchers must engage with the evolving mathematics education environment and community by innovating and reimagining their research tools and techniques.

Background and aims: A health warning label (HWL) cautioning about the link between alcohol and cancer may be able to communicate alcohol risks to consumers and potentially counter health‐oriented nutrition advertising on ready‐to‐drink alcoholic beverages. This study aimed to examine the independent and combined effects of nutrient content claims (e.g. 0 g sugar) and a HWL on perceived product characteristics and intentions to consume, and whether these effects differed by gender and age. Design: A between‐subjects randomized experiment. Participants were randomized to view one of six experimental label conditions: nutrient content claims plus nutrition declaration (NCC + ND), ND only, NCC + ND + HWL, ND + HWL, HWL only and no NCC, ND or HWL, all on a ready‐to‐drink (RTD) vodka‐based soda container. Setting and participants: Alcohol consumers (n = 5063; 52% women) in Canada aged 18–64 recruited through a national online panel. Measurements Participants completed ratings of perceived product characteristics, perceived product health risks, and intentions to try, buy, binge and drink the product. Findings Compared with the reference condition NCC + ND (current policy scenario in Canada), the other five experimental label conditions were associated with lower ratings for perceiving the product as healthy. All experimental conditions with a HWL were associated with lower product appeal, higher risk perceptions and reduced intentions to try, buy and binge. The experimental condition with a HWL only was associated with intentions to consume fewer cans in the next 7 days (β = −0.72, 95% confidence interval [CI] = −1.37,−0.08) versus the reference. Few interactions were observed, suggesting that label effects on outcomes were similar by gender and age. Conclusions: Health warning labels on alcohol packaging appear to be associated with lower product appeal, higher perceived health risks and reduced consumption intentions, even in the presence of nutrient content claims. [ABSTRACT FROM AUTHOR]

Background: Helicobacter pylori infection is prevalent worldwide and can lead to peptic ulcer disease (PUD) and gastric cancer. Effective diagnosis and treatment of H. pylori infection by gastroenterologists and family physicians is crucial. However, there are differing views on optimal diagnosis and treatment. The objective of this study is to understand the impressions of Canadian physicians regarding H. pylori diagnosis and treatment and whether impressions differ between gastroenterologists and family physicians. A second objective is to understand physician perspectives on rising antibiotic resistance and how that guides empiric management. Methods: A survey facilitated via REDCap was administered to Canadian gastroenterologists and family physicians. A total of 105 participants completed the survey, including 43 gastroenterologists and 62 family physicians. Gastroenterologists were recruited from across the country and family physicians were recruited from Manitoba. Results: For diagnosis of H. pylori, 67% of gastroenterologists reported endoscopic biopsies for histology assessment as most common and 73% of family physicians reported serology as their main diagnostic test. While nearly all gastroenterologists believed antibiotic resistance to be a problem, nearly one quarter of family physicians did not believe it was a problem. Conclusions: There is variability in practices among both gastroenterologists and family physicians regarding diagnosis of H. pylori infection. There was consensus that local antibiotic resistance patterns should guide management. If known, the degree and patterns of antibiotic resistance could bring a more uniform consensus to H. pylori management. Greater education of physicians, especially family physicians regarding management of H pylori is needed. [ABSTRACT FROM AUTHOR]

We investigated trophic transfer of cadmium (Cd) through an Arctic marine food web in Hudson Bay and compared it with mercury (Hg), a metal known to strongly biomagnify. We evaluated blue mussel, sea urchin, common eider, sculpin, Arctic cod, and ringed seal for the influence of dietary and biological variables on variation in Cd and Hg concentrations. Age and size influenced metal concentrations among individuals within a vertebrate species. Consumer carbon and sulfur isotope values were correlated with their Cd and Hg concentrations, indicating habitat-specific feeding influenced metal bioaccumulation. Trophic transfer patterns for Cd depended on the vertebrate tissue, with food web biodilution observed for the muscle but not the liver. Liver Cd concentrations were higher in ringed seal and some common eider relative to prey. In contrast, we observed mercury biomagnification for both tissues. Tissue- and species-specific physiology can explain discrepancies of Cd trophic transfer in this Arctic marine food web. [ABSTRACT FROM AUTHOR]

Context: Examination of factors related to the retention or voluntary turnover of Registered Nurses (RNs) has mainly focused on urban, acute care settings. Purpose: This paper explored predictors of intent to leave (ITL) a nursing position in all rural and remote practice settings in Canada. Based on the conceptual framework developed for this project, potential predictors of ITL were related to the individual RN worker, the workplace, the community context, and satisfaction related to both the workplace and the community(s) within which the RN lived and worked. Methods: A national cross-sectional mail survey of RNs in rural and remote Canada provided the data (n = 3,051) for the logistic regression analysis of predictors of ITL. Findings: We found that RNs were more likely to plan to leave their nursing position within the next 12 months if they: were male, reported higher perceived stress, did not have dependent children or relatives, had higher education, were employed by their primary agency for a shorter time, had lower community satisfaction, had greater dissatisfaction with job scheduling, had lower satisfaction with their autonomy in the workplace, were required to be on call, performed advanced decisions or practice, and worked in a remote setting. Conclusions: The statistical evidence for predictors of ITL supported our framework with determinants related to the individual, the workplace, the community, and satisfaction levels. The importance of community makes this framework uniquely relevant to the rural health context. Our findings should guide policy makers and employers in developing retention strategies. (Contains 1 figure and 3 tables.)

Canadians are experiencing increased life expectancy and chronic illness requiring end-of-life care. There is limited research on the multiple roles for family members providing home-based palliative care. Based on a larger ethnographic study of client-family-provider relationships in home-based palliative care, this qualitative secondary analysis explores the enactment of multiple roles for family members providing home-based palliative care to seniors with advanced cancer. Family members had multiple expectations to provide care but felt their expectations of services were unmet. The process of enacting multiple roles was depicted by three interrelated themes: balancing, re-prioritizing, and evolving. Positive and negative health responses resulted from attempts to minimize personal health while simultaneously maintaining health. "True" family-centred care was found to be lacking, but should be a goal of health professionals involved in end-of-life care.

The purpose of this research was to examine the characteristics of older Canadians with dementia (compared to those without dementia), their use of health care services, and the impact of place (rural/urban) on use of services. Andersen and Newman's Behavioural Model of Health Services Use (1973) guided the study. A cross-sectional design used data from the Canadian Community Health Survey (CCHS) Cycle 1.1 (N 1/4 49,995 older Canadians; those with dementia 1/4 313). Results indicated that among Canadian females between the ages of 50 and 64, those with dementia were more likely than those without dementia to live in rural areas. Among females 80 years of age and over, those with dementia had higher levels of education and income than those without dementia. In addition, a higher proportion of white than of visible minority Canadians was afflicted with dementia. The results further suggest that Canadians with dementia primarily required support services and that they were more likely than persons without dementia to report that their health care needs were unmet. It is recommended that publicly funded national home care programs be expanded to ensure that the supportive services needed by this population are available.

Forensic entomology has been developing globally for decades. Despite this discipline being used in criminal investigations around the world, only a few controlled studies have been performed on human cadavers in human decomposition facilities, with the majority of these being conducted in warm and often dry climates. Therefore, the purpose of our research was to catalogue the first published data on insects associated with decomposed human bodies in a humid, continental (Dfb) climate. Specifically, our objective was to document the diversity and succession of the entomofauna associated with human cadavers throughout the decomposition process, in the Quebec province of Canada, during the summer season. Two human cadavers were studied in 2020 at the site for Research in Experimental and Social Thanatology, REST, located in Bécancour (Quebec, Canada). Insects (and other arthropods) were regularly sampled by visual observations, collection from the cadavers, and by using an entomological net and pitfall traps. Our results highlight that the decomposition process is a heterogeneous and complex process in Quebec, with cadavers showing signs of precocious desiccation/mummification. In addition, our observations confirm that the presence of superficial skin lesions accelerates the colonization of blow flies (Diptera: Calliphoridae) and, consequently, the process of decomposition. Finally, we were able to discriminate between "early colonizers" (e.g., Calliphoridae Lucilia sp. or Calliphora livida), "late colonizers" (e.g., larvae of Piophilidae or Heleomyzidae), and "non-specific colonizers." We also officially report the first observation of Cochliomyia macellaria (Diptera: Calliphoridae) in Quebec. These findings will provide new information to help medico-legal death investigations by determining the minimum time elapsed since death and the circumstances surrounding death. [ABSTRACT FROM AUTHOR]

The published literature shows a lack of methods to evaluate the patterns and extent of decomposition of human remains and to estimate the post‐mortem interval (PMI) in humid, continental (Dfb) climates such as Quebec. The aim of this study was to address this gap in the current knowledge base by providing the first observations from human corpses studied under controlled conditions in Quebec. A 12‐month study was conducted at the site for Research in Experimental and Social Thanatology; the first human taphonomy facility in Canada. Six human donors with known time of death were deposited across spring (n = 1), summer (n = 3), and autumn (n = 2) 2021. The lack of suitability of the total body score method to evaluate the extent of decomposition at the facility prompted the development of a new scoring system based on the macromorphoscopic changes observed. The scoring system was applied to the donors to evaluate decomposition throughout seasons. All donors followed comparable decomposition trajectories, regardless of the season of deposition. Eighty‐five percent of taphonomic patterns appeared in the first 25 experimental days or 5000 Kelvin accumulated degree days (350 ADD). Extensive desiccation of tissues was observed at a median of 21 experimental days across donors, resulting in a plateau within decomposition with no extensive skeletonization. To the authors' knowledge, this is the first published report of experimentally observed desiccation in such a form in a Dfb climate. This study provides new data on the types of decomposition patterns to expect in forensic investigations in southern Quebec and comparable climates. [ABSTRACT FROM AUTHOR]

Summary: Background: Cannabinoid hyperemesis syndrome (CHS) is a poorly understood vomiting disorder associated with chronic cannabis use. Aims: To characterise patients experiencing CHS in North America and to obtain a population‐based estimate of CHS treatment prevalence in Canada before and during the Covid‐19 pandemic Methods: Internet survey of 157 CHS sufferers in Canada and the United States. Administrative health databases for the province of Alberta (population 5 million) were accessed to measure emergency department (ED) visits for vomiting, with a concurrent diagnostic code for cannabis use. Three time periods of 1 year were assessed: prior to recreational cannabis legalisation (2017–2018), after recreational legalisation (2018–2019) and during the first year of the Covid‐19 pandemic (2020–2021). Results: Problematic cannabis use (defined as a CUDIT‐R score ≥8) was universal among the survey cohort, and 59% and 68% screening for moderate or worse anxiety or depression, respectively. The overall treatment prevalence of CHS across all ages increased from 15 ED visits per 100,000 population (95% CI, 14–17) prior to legalisation, to 21 (95% CI, 20–23) after legalisation, to 32 (95% CI, 31–35) during the beginning of the Covid‐19 pandemic (p < 0.001). Treatment prevalence among chronic cannabis users was as high as 6 per 1000 in the 16–24 age group. Conclusion: Survey data suggest patients with CHS almost universally suffer from a cannabis use disorder, which has significant treatment implications. Treatment prevalence in the ED has increased substantially over a very short time period, with the highest rates seen during the Covid‐19 pandemic. [ABSTRACT FROM AUTHOR]

Background: During the period of monkeypox community transmission and restricted vaccine supply in the summer of 2022, Canadian provinces and territories and a number of vaccine stakeholders indicated the need for consistent national guidance on pre-exposure vaccination (including the identification of priority populations for pre-exposure vaccination programs) and guidance on the potential use of dose-sparing strategies. Methods: The National Advisory Committee on Immunization (NACI) High Consequence Infectious Disease Working Group reviewed data on the status of the monkeypox outbreak along with additional published and non-published evidence regarding the safety, immunogenicity and protection offered by Imvamune®. NACI approved updated recommendations on September 16, 2022, and on September 23, 2022 it released updated interim guidance on the use of Imvamune in the context of the ongoing monkeypox outbreak. Results: During periods of adequate vaccine supply, NACI recommended that Imvamune preexposure vaccination should be offered as a two-dose primary series, with at least 28 days between the two sub-cutaneous doses. When supply is limited, guidance was provided for the use of dose sparing strategies, including extended dosing intervals and fractional intradermal dosing to maximize vaccine coverage for those at highest risk of exposure to the monkeypox virus. Conclusion: The updated NACI recommendations provide additional guidance on the use of Imvamune for the management of the 2022 monkeypox outbreak in Canada and may be considered to maximize vaccine coverage in outbreak settings when supply is limited. [ABSTRACT FROM AUTHOR]

Discusses the contemporary university in Canada, focusing on Allan Bloom's "The Closing of the American Mind" which analyzes problems in today's education. The paper calls Bloom's book an unrivaled diagnosis of the impasse of the university, and it examines Bloom's relativistic principles. (SM)

Decomposition of human remains is a complex process impacted by many intrinsic and extrinsic factors. A less‐studied extrinsic factor in forensic taphonomy are the scavengers that consume soft and hard tissue. Scavengers physically degrade and remove soft tissue, disperse, and destroy skeletal elements, which can make locating remains challenging. While invertebrate activity has been largely investigated, there is limited quantitative data available on vertebrate activity, particularly in Canada. This study aimed to determine which species (vertebrate and invertebrate) belong to the scavenger guilds in southern Quebec, and their potential taphonomic impact on the decomposition process. Two independent trials were conducted in 2020 using pig carcasses: one during summer in a forest habitat and one during fall in a grassland habitat. Each carcass was placed a minimum 100 m apart in semi‐rural land. Vertebrate scavenger activity was recorded by continuous surveillance using trail cameras. Carcasses were also regularly visited to monitor the decomposition process and the activity of invertebrate scavengers. Overall, the vertebrate scavenger guilds included a narrow range of corvids, turkey vultures, coyotes, and skunks. The intensity of vertebrate scavengers was greater in the grassland habitat (fall), while the intensity of invertebrate scavengers was greater in the forest habitat (summer). With the exception of invertebrate scavengers, very few species visited during the fresh stage of decomposition, and the probability of body displacement increased as decomposition progressed. These results identify which scavengers have the greatest taphonomic impact and highlight the importance of incorporating scavenger impact when searching for human remains. [ABSTRACT FROM AUTHOR]

This study examined if acute dietary nitrate supplementation (140 mL beetroot juice, BRJ) would reduce oxygen consumption (V̇O2) during cycling at power outputs of 50 and 70% maximal oxygen consumption in 14 well-trained female Canadian University Ringette League athletes. BRJ had no effect on V̇O2 or heart rate but significantly reduced ratings of perceived exertion (RPE) at both intensities. Individually, 4 participants responded to BRJ supplementation with a ≥3% reduction in V̇O2 at the higher power output. Novelty: Acute BRJ supplementation did not improve exercise economy in well-trained females, but significantly reduced RPE. However, 4/14 subjects did respond with a ≥3% V̇O2 reduction. [ABSTRACT FROM AUTHOR]

Many long-term survivors of childhood cancer (LTSCC), individuals at least 5 years post-diagnosis or 2 years post-treatment, experience late- and long-term effects from their treatments, including pain. Yet, pain is poorly understood among LTSCC. The current study aimed to (1a) describe rates and multiple dimensions of pain; (1b) identify patterns of chronic pain; and (2) test correlates of chronic pain in LTSCC. Survivors (n = 140; 48.6% male, Mage = 17.3 years (range = 8–25)) were recruited from across Canada. Between 2017 and 2019, participants completed the Pain Questionnaire, Pain Catastrophizing Scale, Pediatric Quality of Life Inventory, Patient-Reported Outcome Measurement Information System (PROMIS)–Pain Interference, Anxiety, and Depression scales, Child Posttraumatic Stress Scale, the Posttraumatic Stress Disorder Checklist for the DSM-V, and the Cancer Worry Scale. Results: Twenty-six percent of LTSCC reported experiencing chronic pain. Exploratory cluster analysis showed 20% of survivors had moderate to severe chronic pain based on measures of pain intensity and interference. The combination of higher posttraumatic stress symptoms, older current age, more pain catastrophizing, and sex (being female) significantly predicted the presence of chronic pain in logistic regression, χ2 (4, N = 107) = 28.10, p <.001. Higher pain catastrophizing (OR = 1.09; 95% CI = 1.02–1.16), older current age (OR = 1.20; 95% CI = 1.07–1.34), and higher posttraumatic stress (OR = 1.92; 95% CI = 1.01–3.63) were significant predictors of chronic pain. LTSCC should be screened for the presence and magnitude of chronic pain during long-term follow-up visits so appropriate interventions can be offered and implemented. Future research should investigate pain interventions tailored for this population. Relevance: Findings support regular screening for the presence and magnitude of chronic pain in survivors of childhood cancer in long-term follow-up care. [ABSTRACT FROM AUTHOR]

The population of Atlantic Canada is aging rapidly and has among the highest rates of chronic disease in the country. This cross-sectional study drew data from the Atlantic Partnership for Tomorrow's Health (Atlantic PATH) study to investigate the association between physical activity and self-rated health among adults in this population. The results suggest that physical activity is associated with and may help to improve perceived health status of individuals with one or more chronic conditions. The findings support literature suggesting that physical activity can be beneficial for adults as they age with chronic disease. [ABSTRACT FROM AUTHOR]

Purpose: Most patients diagnosed with cancer are administered systemic therapy and these patients are counselled and given printed education (PE) materials. High rates of low health literacy highlight the need to evaluate the quality of these PE materials.Methods: A current state assessment of the quality of PE materials was conducted in Ontario, Canada. Patient education leaders from 14 cancer centres submitted print materials on the topic of systemic cancer therapy to the assessment team. To report adherence to PE quality and health literacy best practices, the following validated measures were used: readability (FRY, SMOG and Flesch Reading Ease), understandability and actionability (Patient Education Materials Assessment Tool (PEMAT)). Materials at grade level 6 or lower and with PEMAT scores greater than 80% were considered to meet health literacy best practices.Results: A total of 1146 materials were submitted; 366 met inclusion criteria and 83 were selected for assessment. Most materials scored below the 80% target for understandability (x̄ = 73%, 31-100%) and actionability (x̄ = 68%, 20-100%), and above the recommended grade 6 readability level (x̄ = grade 9) meaning that the majority did not meet quality standards or best practices.Conclusion: Results suggest that there is significant opportunity to improve the quality of PE materials distributed by cancer centres. The quality of PE materials is a critical safety and equity consideration when these materials convey important safety and self-care directives. [ABSTRACT FROM AUTHOR]

Background and Aims: Gastrointestinal manifestations in patients with COVID-19 are common but the role of endoscopy in this patient population remains unclear. We investigated the need for endoscopic procedures, their findings, and impact on patient care in a systematic and geographically diverse sample of patients hospitalized with COVID-19.Methods: As part of the North American Alliance for the Study of Digestive Manifestations of COVID-19, we identified consecutive patients hospitalized with COVID-19 at 36 medical centers in the USA and Canada. We performed a secondary analysis of patients who underwent endoscopy, collecting information on endoscopic indications, findings, interventions, staffing, procedure location, anesthesia utilization, and adverse events.Results: Data were collected on 1992 patients; 24 (1.2%) underwent 27 endoscopic procedures (18 upper endoscopies, 7 colonoscopies, 2 endoscopic retrograde cholangiopancreatographies). The most common indications were: gastrointestinal bleeding (13) and enteral access (6). The most common findings were erosive or inflammatory changes. Ten patients underwent an endoscopic intervention for hemostatic therapy (2), enteral access (6), or biliary obstruction (2). Half of cases employed anesthesiology support; no sedation-related adverse events were reported. One-third of cases were performed in the intensive care setting and one quarter in the endoscopy unit.Conclusions: In this large, systematic, geographically diverse cohort of patients hospitalized with COVID-19 in North America, very few patients underwent endoscopy despite a high prevalence of gastrointestinal manifestations. Almost all endoscopic findings and interventions were thought related to critical illness rather than direct viral injury. This systematic assessment of endoscopic necessity and outcomes may help guide resource allocation in the event of ongoing and future surges. [ABSTRACT FROM AUTHOR]

Background: Recent changes to the legal status of marijuana in Canada warrant a review of the information that patients and families are accessing online regarding the role of cannabis in cancer. The aims of the current research were to identify the quality of literature available online as well as the themes, and opinion (i.e., pro-, neutral, or anti-cannabis) of online articles.Methods: Searches were conducted using three primary search engines: Google, Yahoo, and DuckDuckGo. Articles were assessed for quality based on a modified scale for evaluating online sources. Content of all unique articles was coded using a qualitative thematic methodology in a line-by-line fashion. Codes were clustered to determine themes within articles. Finally, opinions were determined by examining all articles in a line-by-line fashion. Each statement was coded as either pro-cannabis (positive) or anti-cannabis (negative).Results: We found most articles were authored by journalists (39.4%) and MDs (14.1%) and published as news (35.2%) or web articles (28.2%). The content of articles focused on four themes: the reasons for and against cannabis use; the opinions of health care providers; the restrictions placed by governing bodies and the need for additional research, education, and standardization. Article opinions were neutral-pro-cannabis.Conclusions: Health care providers should be aware that the overall quality of information found online is considered "satisfactory." The majority of articles present a pro-cannabis opinion. [ABSTRACT FROM AUTHOR]

Mi'kmaq Elder Albert Marshall coined "Two-Eyed Seeing" in 2004, an Indigenous concept that emphasizes integrating the strengths of multiple perspectives to address complex challenges in ways that benefit all. In 2011, Two-Eyed Seeing became a policy of the Canadian Institutes of Health Research (CIHR)–Institute of Aboriginal Peoples' Health, as a part of its 5-year plan, and in 2012, CIHR funding was directed toward supporting efforts that apply the concept of Two-Eyed Seeing to research. However, little is known about how Two-Eyed Seeing has been operationalized in research. To address this ambiguity, a scoping review was conducted to map the key concepts involved when researchers intend to follow Two-Eyed Seeing guiding principles to study Indigenous health topics. Three research questions guided this scoping review: (1) What are the general characteristics (e.g., location of study, health topic studied) of primary research that has attempted to apply Two-Eyed Seeing when studying Indigenous health topics? (2) How did researchers operationalize the concept of Two-Eyed Seeing when they applied it to primary studies regarding Indigenous health topics? and (3) What process-related elements were present in Two-Eyed Seeing studies that accomplished their objectives? The results of this scoping review indicate there is an increasing trend in Two-Eyed Seeing–related peer-reviewed publications since its formal introduction by Mi'kmaq Elder Albert Marshall. The selected Two-Eyed Seeing–related projects were predominately conducted in Canada and published between 2011 and 2019. Projects predominately incorporated a community-based (participatory) research approach and qualitative/Indigenous methods, and six core process–related themes/elements were identified: (i) power was shared, (ii) culturally safe spaces were fostered, (iii) institutional and community ethics were followed, (iv) research projects were transformative, (v) rigor was maintained, and (vi) the structure of Western academia and traditional policy decision-making processes provided challenges for research teams and community partners, respectively. [ABSTRACT FROM AUTHOR]

Background: Endoscopic retrograde cholangio-pancreatography (ERCP) is commonly performed in the management of pancreatic and biliary disease. Duodenoscopes are specialized endoscopes used to perform ERCP, and inherent to their design, a high rate of persistent bacterial contamination exists even after automated reprocessing and disinfection. Consequently, in recent years, ERCP has been associated with infection transmission, leading to several fatal patient outbreaks. Due to increasing fears over widespread future duodenoscope-related outbreaks, regulatory bodies have called for alterations in the design of duodenoscopes. A duodenoscope has recently been developed that employs a disposable cap. This novel design theoretically eliminates the mechanism behind persistent bacterial contamination and infection transmission. However, there are no data demonstrating persistent bacterial contamination rates, technical success rates, or clinical outcomes associated with these duodenoscopes.Methods: A parallel arm randomized controlled trial will be performed for which 520 patients will be recruited. The study population will consist of consecutive patients undergoing ERCP procedures for any indication at a high-volume tertiary care centre in Calgary, Alberta, Canada. Patients will be randomized to an intervention group, that will undergo ERCP with a novel duodenoscope with disposable cap, or to a control group who will undergo ERCP with a traditional duodenoscope. Co-primary outcomes will include persistent bacterial contamination rates (post automated reprocessing) and ERCP technical success rates. Secondary outcomes include clinical success rates, overall and specific early and late adverse event rates, 30-day mortality and healthcare utilization rates, procedure and reprocessing times, and ease of device use.Discussion: The ICECAP trial will answer important questions regarding the use of a novel duodenoscope with disposable cap. Specifically, persistent bacterial contamination, technical performance, and relevant clinical outcomes will be assessed. Given the mortality and morbidity burden associated with ERCP-related infectious outbreaks, the results of this study have the capacity to be impactful at an international level.Trial Registration: This trial was registered on clinicaltrials.gov (NCT04040504) on July 31, 2019. [ABSTRACT FROM AUTHOR]

Purpose: To describe and compare the sociodemographic and lifestyle characteristics of urban and rural residents in Atlantic Canada. Methods: Cross‐sectional analyses of baseline data from the Atlantic Partnership for Tomorrow's Health cohort were conducted. Specifically, 17,054 adults (35‐69 years) who provided sociodemographic characteristics, measures of obesity, and a record of chronic disease and health behaviors were included in the analyses. Multiple linear regression and logistic regression models were used to calculate the multivariable‐adjusted beta coefficients (β), odds ratios (OR), and related 95% confidence intervals (CI). Findings: After adjusting for age, sex, and province, when compared to urban participants, rural residents were significantly more likely to: be classified as very active (OR: 1.19, CI: 1.11‐1.27), be obese (OR: 1.13, 1.05‐1.21), to present with abdominal obesity (OR: 1.08, CI: 1.01‐1.15), and have a higher body fat percentage (β: 0.40, CI: 0.12‐0.68) and fat mass index (β: 0.32, CI: 0.19‐0.46). Rural residents were significantly less likely to be regular or habitual drinkers (OR: 0.83, CI: 0.78‐0.89). Significant differences remained after further adjustment for confounding sociodemographic, lifestyle, and health characteristics. No significant differences in smoking behavior, fruit and vegetable intake, multimorbidity, or waist circumference were found. Conclusions: As expected, obesity prevalence was higher in rural Atlantic Canadians. In contrast to much of the existing literature, we found that rural participants were more likely to report higher levels of total physical activity and lower alcohol consumption. Findings suggest that novel obesity prevention strategies may be needed for rural populations. [ABSTRACT FROM AUTHOR]

Stepped-wedge cluster randomized trials, which randomize clusters of subjects to treatment sequences in which clusters switch from control to intervention conditions, are being conducted with increasing frequency. Due to the real-world nature of this design, methodological and implementation challenges are ubiquitous. To account for such challenges, more complex statistical models to plan studies and analyze data are required. In this paper, we consider stepped-wedge trials that accommodate treatment effect heterogeneity across clusters, implementation periods during which no data are collected, or both treatment effect heterogeneity and implementation periods. Previous work has shown that the sequence-period cells of a stepped-wedge design contribute unequal amounts of information to the estimation of the treatment effect. In this paper, we extend that work by considering the amount of information available for the estimation of the treatment effect in each sequence-period cell, sequence, and period of stepped-wedge trials with more complex designs and outcome models. When either treatment effect heterogeneity and/or implementation periods are present, the pattern of information content of sequence-period cells tends to be clustered around the times of the switch from control to intervention condition, similarly to when these complexities are absent. However, the presence and degree of treatment effect heterogeneity and the number of implementation periods can influence the information content of periods and sequences markedly. [ABSTRACT FROM AUTHOR]

Butternut (Juglans cinerea L. [Juglandaceae]) is a native tree in the US and Canada that is in rapid decline due to an introduced fungal pathogen (Ophiognomonia clavigignenti juglandacearum [Oc-j]). Resistance to the disease has not been identified, and conservation efforts for this nut-producing species have concentrated on the ex situ cryogenic storage of germplasm. The conventional method for growing butternut uses the nut. In general, Juglans species exhibit seed dormancy, which can be broken by cold, moist stratification at 1-4 °C (32-39.2 °F) for 90-120 d. Stratified nuts usually germinate within 4 wk, with variation among seeds. Average germination by the conventional method is approximately 60% for J. cinerea. A new in vitro germination protocol has been developed for the production of butternut seedlings that results in high germination and acclimatization success (conversion of germinants growing on medium to seedlings growing in soil) for both cryogenically and non-cryogenically stored embryonic axes (root-shoot axis). This protocol eliminates the need for conventional nut stratification; produces decontaminated tissue via surface sterilization, such that seedlings are visibly canker-free; increases germination; and enables long-term cryogenic storage. [ABSTRACT FROM AUTHOR]

Background: Postoperative ileus is a poorly understood multifactorial outcome following colorectal surgery that presents significant clinical challenges and contributes to increased morbidity, length of stay, and healthcare cost. To date, there are few pharmacological interventions that shorten the duration of postoperative ileus.Objective: This study is the first to evaluate the efficacy of simethicone in treating postoperative ileus symptoms in patients undergoing colorectal surgery.Design: A multicenter, double-blinded, placebo controlled randomized controlled trial.Settings: This trial was conducted at two academic tertiary care centres in Ontario, Canada.Participants: 118 patients undergoing colorectal surgery.Interventions: Patients were randomized to receive either a five-day course of oral simethicone (n = 58) or a placebo (n = 60).Main Outcome Measures: The primary outcome was time to first passage of flatus. Secondary outcomes included time to first bowel movement, postoperative length of stay, and postoperative pain. Statistical analyses were performed on an intention-to-treat basis. Statistical significance set at p = 0.05.Results: The median time to first passage of flatus in simethicone arm was 25.2 h and 26.7 h in controls (P = 0.98). There were no significant differences in the median time to first bowel movement (simethicone = 41.1 h vs. control = 42.9 h, P = 0.91) or median length of hospital stay (simethicone = 4.5 days vs. control = 4.0 days, P = 0.63).Conclusions: This study failed to show a difference in return of gastrointestinal motility in patients receiving simethicone following colorectal surgery. Postoperative ileus remains a significant clinical and economic burden to the healthcare system and further research is needed to identify a reliable and effective method of treatment. [ABSTRACT FROM AUTHOR]

Background: Understanding what influences people to seek help can inform interventions to promote earlier diagnosis of cancer, and ultimately better cancer survival. We aimed to examine relationships between negative cancer beliefs, recognition of cancer symptoms and how long people think they would take to go to the doctor with possible cancer symptoms (anticipated patient intervals).Methods: Telephone interviews of 20,814 individuals (50+) in the United Kingdom, Australia, Canada, Denmark, Norway and Sweden were carried out using the Awareness and Beliefs about Cancer Measure (ABC). ABC included items on cancer beliefs, recognition of cancer symptoms and anticipated time to help-seeking for cough and rectal bleeding. The anticipated time to help-seeking was dichotomised as over one month for persistent cough and over one week for rectal bleeding.Results: Not recognising persistent cough/hoarseness and unexplained bleeding as cancer symptoms increased the likelihood of a longer anticipated patient interval for persistent cough (OR = 1.66; 95%CI = 1.47-1.87) and rectal bleeding (OR = 1.90; 95%CI = 1.58-2.30), respectively. Endorsing four or more out of six negative beliefs about cancer increased the likelihood of longer anticipated patient intervals for persistent cough and rectal bleeding (OR = 2.18; 95%CI = 1.71-2.78 and OR = 1.97; 95%CI = 1.51-2.57). Many negative beliefs about cancer moderated the relationship between not recognising unexplained bleeding as a cancer symptom and longer anticipated patient interval for rectal bleeding (p = 0.005).Conclusions: Intervention studies should address both negative beliefs about cancer and knowledge of symptoms to optimise the effect. [ABSTRACT FROM AUTHOR]

This article examines the religious rhetoric among revolutionaries in the Upper Canada Rebellion of 1837 in several regions of the Canadian colonies. Topics include the call to arms appeal by radical journalist William Lyon Mackenzie against abuses of executive power; rebellion led directly by Mackenzie at Montgomery's Tavern on Yonge Street north of Toronto, Ontario; Christianity's role in Canadian radical politics; and recruitment for the rebellion by the Protestant dissenters.

We examined hepatic concentrations of arsenic (As), cadmium (Cd), copper (Cu), lead (Pb), manganese (Mn), mercury (Hg), rubidium (Rb), selenium (Se) and zinc (Zn) in 10 breeding female common eiders ( Somateria mollissima ) from each of three colonies across 20° of latitude. Levels of many elements were elevated in eiders, although generally below levels of toxicological concern. We found significant differences in concentrations of As, Rb, Hg, Mn and Se among colonies, but not in a consistent pattern with latitude, and Hg:Se molar ratios did not vary among colonies. Furthermore, overlap in element concentrations from birds at different colonies meant that we could not reliably differentiate birds from different colonies based on a suite of their hepatic trace element concentrations. We encourage other researchers to assess baseline trace element levels on this important, harvested species, as a means of tracking contamination of nearshore benthic environments in the circumpolar Arctic. [ABSTRACT FROM AUTHOR]

Background: Cancer survival in the UK and Denmark are lower when compared with similar countries with late diagnosis a possible cause. We aimed to study the relationship between barriers to attending a primary care physician (GP) and anticipated time to help seeking (ATHS) with four cancer symptoms in six countries. Methods: A population-based survey measuring cancer awareness and beliefs conducted within the International Cancer Benchmarking Partnership in Australia, Canada, Denmark, Norway, Sweden and UK. Data were collected on perceived barriers to GP consultation (including embarrassment, worry about wasting the doctors' time, fear about what the doctor might find and being too busy) and ATHS for persistent cough, abdominal swelling, rectal bleeding and breast changes. Relationships between perceived barriers and ATHS were investigated using multivariable analysis. Results: Among 19079 respondents, higher perceived barrier scores were associated with longer ATHS intervals for all symptoms studied (P<0.01) responders with the highest barrier scores (>10.84) had between two and three times the odds of longer ATHS. ATHS was low in Australia for all symptoms and highest in Denmark for abdominal bloating. Conclusions: Perceived barriers to help-seeking have a role in delaying GP presentation. Early diagnosis campaigns should address emotional and practical barriers that reduce early presentation with potential cancer symptoms. [ABSTRACT FROM AUTHOR]

Background: Family carers of older persons with Alzheimer's' disease and related dementia (ADRD) and multiple chronic conditions (MCC) experience significant, complex, and distressing transitions such as changes to their environment, roles and relationships, physical health, and mental health. An online intervention (My Tools 4 Care) was developed for family carers of persons with ADRD and MCC living at home, with the aim of supporting these carers through transitions and increasing their self-efficacy, hope, and health related quality of life (HRQoL). This study will evaluate My Tools 4 Care (MT4C) by asking the following research questions: 1. Does use of MT4C result in a 3 month (immediately post intervention) and 6-month (3 months after intervention) increase in HRQoL, self-efficacy, and hope, in carers of persons with ADRD and MCC compared to an educational control group? 2. Does use of MT4C help carers of community-dwelling older adults with ADRD and MCC deal with significant changes they experience as carers? and 3. Are the effects/benefits of the MT4C intervention achieved at no additional cost compared to an educational control group?Methods/design: Using a pragmatic mixed methods randomized controlled trial design, 180 family carers of community dwelling older persons (65 years of age and older) with ADRD and MCC will participate in the study. Data will be collected from the intervention and an educational control group at four time points: baseline, 1 month, 3 and 6 months. We expect to find that family carers using MT4C will show greater improvement in hope, self-efficacy and HRQoL, at no additional cost from a societal perspective, compared to those in the educational control group. General estimating equations will be used to determine differences between groups and over time.Discussion: Data collection began in Ontario and Alberta Canada in June 2015 and is expected to be completed in June 2017. The results will inform policy and practice as MT4C can be easily revised for local contexts and is scalable in terms of posting on websites such as those hosted by the Alzheimer Society.Trial Registration: ClinicalTrials.gov Identifier: NCT02428387. [ABSTRACT FROM AUTHOR]

Background: The heterogeneity of medical complications that lead to amputation has resulted in a diverse patient population with differing rehabilitation needs; however, the rehabilitation trends for patients with lower extremity amputations across Canada have not been studied previously.Objective: To describe trends in rehabilitation after lower extremity amputations and the factors affecting rehabilitation length of stay in Canada.Design: Retrospective cohort analysis.Setting: Canadian inpatient rehabilitation facilities that received persons with lower extremity amputations discharged from academic or community hospitals.Participants: Patients underwent lower extremity amputations between 2006 and 2009 for nontraumatic indications and were then discharged to a rehabilitation facility. Patients were identified from the Canadian Institute for Health Information's Discharge Abstract Database that includes hospital admissions across Canada except Quebec.Interventions: Inpatient rehabilitation after lower extremity amputations.Main Outcome Measures: Length of stay, discharge destination, and change in total and motor function scores.Results: The analysis included 5342 persons who underwent lower extremity amputations, 1904 of whom were transferred to a rehabilitation facility (36%). Patients most commonly underwent single below-knee (74%) and above-knee (17%) amputations. The duration of rehabilitation varied by whether the amputation was performed by a vascular (median = 36 days), orthopedic (median = 38 days), or general surgeon (median = 35 days). The overall median length of stay was 36 days. Most patients (72%) subsequently were discharged home and 9% were readmitted to hospital. Predictors of longer rehabilitation included amputation by an orthopedic surgeon (beta = 5.0, P ≤ .01), older age (beta = 0.2, P ≤ .01), and a history of ischemic heart disease (beta = 3.8, P = .03) or congestive heart failure (beta = 5, P = .04). Patients who spent <7 days in hospital were significantly more likely to have a shorter rehabilitation stay (beta = -4, P = .03). Advanced patient age was the only predictor for hospital readmission (odds ratio = 1.03, P ≤ .01).Conclusions: Rehabilitation length of stay in Canada after lower extremity amputation varies by the type of surgeon performing the amputation. Advanced age, undergoing surgery in the province of Manitoba, and having a history of ischemic heart disease or congestive heart failure predict a longer rehabilitation stay. A shorter perioperative hospitalization period (<7 days) predicts a shorter rehabilitation duration. Future studies are needed to explore these issues and to optimize the delivery of rehabilitation services to Canadians after lower extremity amputation.Level Of Evidence: II. [ABSTRACT FROM AUTHOR]

In comparison to athletes and coaches, sport officials have received relatively little attention from the sport science community. The purpose of this investigation was to examine resilience, participation motivations, and perceptions of organizational support for those officiating aesthetic sports. Seventy-six (62 females, 14 males) Canadian officials from diving, figure skating, artistic and rhythmic gymnastics, and synchronized swimming volunteered to participate. They completed measures of resilience, motivation, and POS and provided qualitative responses to a series of open-ended questions. The results indicated that they were highly resilient and motivated to participate because of their love for the sport and desire to stay connected to the sports' social communities. Univariate ANOVA procedures revealed significant differences, including three-way interaction effects in measures of resilience, motivation (i.e., extrinsic motivation as introjected regulation, amotivation), and POS by sex, officiating rank, and officiating setting. Implications for sport and officiating administrators are discussed. [ABSTRACT FROM AUTHOR]

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Copyright of Environmental Reviews is the property of Canadian Science Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)